Provider Demographics
NPI:1023313848
Name:RAIMO, ANGELA MARY (DPM)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:MARY
Last Name:RAIMO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:304 COMMUNITY DR
Mailing Address - Street 2:APT 2J
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3834
Mailing Address - Country:US
Mailing Address - Phone:631-512-2021
Mailing Address - Fax:
Practice Address - Street 1:1540 WILLISTON RD
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6422
Practice Address - Country:US
Practice Address - Phone:802-862-8666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-26
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6420213E00000X
VT056-0000182213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist